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MONITORING WELL INSTALLATION REPORT <br /> Date: b -L Ti O CONSTRUCTION <br /> Premise Address: 1601. �- 1�t�ti 5_5 Total Depth �S <br /> Screen Length (from) 6 S ` _(to) 35 ' <br /> Well No. (to)Pk (from) <br /> Bentonite (from) (to) <br /> Insuecror. Grout (from) (to) <br /> Dig ng type <br /> Auger O.D. I.D. <br /> Permit NO. 3 3 Completion-Stove pipe/christie iox (circle one) <br /> Drilling Company- P&-i c n Lk L (L <br /> Driller. C� casing <br /> height <br /> Consultant r O'A _3 <br /> Geologist <br /> A.3CY:-uRCUPID CHRiS 1 Y-3CX <br /> C"tnP:.T-AN C—OMPI ,ICN <br /> SPECIAL PERIN i INFO. Gk�sa'cs <br /> a <br /> Distance to sewer line <br /> Domestic we-11 �on�ice <br /> yIf yes, location <br /> - — c <br /> SAIIMUNG sJauad — <br /> Holding Temperature <br /> Method " <br /> Screening Method C = <br /> Tracking Sheet - C y/ n ) __ <br /> SPOILS <br /> Storage Method �� MATERIALS/DEVELOPMENT <br /> Contaminarion Noted - C / n ) <br /> Storage Location Casing type '9 r V( <br /> Blank 6 t �ft Screen_ 16 fc <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Death to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size 2 It., <br /> Installation Method Surge Block: - (y/ n ) 1 — <br /> Quantity Installed Discussed with geology - C y/ n ) <br /> Type of method <br /> EH 29 29 <br />